Analyzing cardiac rhythm in the presence of chest compression artifact for automated shock advisory

Abstract

Defibrillation is often required to terminate a ventricular fibrillation or fast ventricular tachycardia rhythm and resume a perfusing rhythm in sudden cardiac arrest patients. Automated external defibrillators rely on automatic ECG analysis algorithms to detect the presence of shockable rhythms before advising the rescuer to deliver a shock. For a reliable rhythm analysis, chest compression must be interrupted to prevent corruption of the ECG waveform due to the artifact induced by the mechanical activity of compressions. However, these hands-off intervals adversely affect the success of treatment. To minimize the hands-off intervals and increase the chance of successful resuscitation, we developed a method which asks for interrupting the compressions only if the underlying ECG rhythm cannot be accurately determined during chest compressions. Using this method only a small percentage of cases need compressions interruption, hence a significant reduction in hands-off time is achieved. Our algorithm comprises a novel filtering technique for the ECG and thoracic impedance waveforms, and an innovative method to combine analysis from both filtered and unfiltered data. Requiring compression interruption for only 14% of cases, our algorithm achieved a sensitivity of 92% and specificity of 99%.

Keywords: AED; Artifact removal; CPR; Cardiac rhythm; Chest compression; Defibrillation; ECG; Hands-off interval; Resuscitation; Shock advisory.